4 ms·

I've not seen a case that what Shkreli did reduced the availability of his niche drug to patients.

ceejayoz 10y ago
That's a strawman. Yes, most patients likely retained their access to the drug. The issue is more that we all wind up paying higher premiums so Shkreli can line his pockets with inflated proceeds and no alternatives.
- microcolonel 10y ago
  I doubt much money is spent on Daraprim overall. $75k is apparently the overall cost of a course of treatment to insurers, in addition to the two or three other drugs prescribed to reduce the side effects of the drug. It is apparently not in common use, Health Canada says that hospitals simply don't buy it anymore as of 2013, well before the price increase. I suspect that if there's an entire first-world nation which no longer purchases the drug in hospitals or pharmacies, sales volume is probably pretty low in the U.S. I don't see what kind of premium increase you could attribute to that.
  - ceejayoz 10y ago
    Wikipedia says it's on the WHO Model List of Essential Medicines, and while the number in the US on it may be low, it's not like this can't be done with other medications.
mikeash 10y ago
Are you proposing that every single patient using Thiola or Daraprim was either able to afford the new price or get someone else to pay for it?
- microcolonel 10y ago
  He outright offered to send the drug at no cost to patients whose insurers did not cover it.
  - mikeash 10y ago
    Before or after his name got dragged through the mud?
    - Neliquat 10y ago
      Its pretty standard for most life saving drugs to be subsidized. Watch the end of many pharma ads in the us. Not saying he is a saint, but in this case you are ascribing malice where there is none.
      - mikeash 10y ago
        I know the guy jacked up the prices for these drugs enormously, and the stuff I found about people getting it for free if their insurance doesn't cover it is after the controversy got rolling, so I don't think I'm ascribing malice so much as describing it.
soundwave106 10y ago
The issue is the reverse. Shkreli used existing FDA regulations to carve out a monopoly -- from what I understand from the Wiki (https://en.wikipedia.org/wiki/Pyrimethamine#cite_note-45 https://en.wikipedia.org/wiki/Pyrimethamine#cite_note-45), he largely leaned on current FDA bioequivalency standards to put a barrier to entry for the business that was higher than many generics would want to risk (given the low volume of the compound). Once the virtual monopoly was obtained, he subsequently jacked up prices. In this he probably made a mistake by being way too greedy. With "ordinary" medication pricing, patients may not notice the very high prices, largely because American medical pricing is not terribly transparent. Instead, the higher costs tend to translate to higher insurance premiums and higher medical bills to the taxpayer. Pyrimethamine is an old 1950s drug and as I understand it the synthesis is relatively easy. If the current American regulatory system wasn't so broken and we had a truly free market, Shkreli wouldn't even have a business plan with that sort of price increase, low volume notwithstanding. The good news out of this is what Shkreli did was so egregious, the flaws in the system ended up being headline news.

That's a strawman. Yes, most patients likely retained their access to the drug. The issue is more that we all wind up paying higher premiums so Shkreli can line his pockets with inflated proceeds and no alternatives.

microcolonel 10y ago
I doubt much money is spent on Daraprim overall. $75k is apparently the overall cost of a course of treatment to insurers, in addition to the two or three other drugs prescribed to reduce the side effects of the drug. It is apparently not in common use, Health Canada says that hospitals simply don't buy it anymore as of 2013, well before the price increase. I suspect that if there's an entire first-world nation which no longer purchases the drug in hospitals or pharmacies, sales volume is probably pretty low in the U.S. I don't see what kind of premium increase you could attribute to that.
- ceejayoz 10y ago
  Wikipedia says it's on the WHO Model List of Essential Medicines, and while the number in the US on it may be low, it's not like this can't be done with other medications.

mikeash 10y ago

Are you proposing that every single patient using Thiola or Daraprim was either able to afford the new price or get someone else to pay for it?

microcolonel 10y ago
He outright offered to send the drug at no cost to patients whose insurers did not cover it.
- mikeash 10y ago
  Before or after his name got dragged through the mud?
  - Neliquat 10y ago
    Its pretty standard for most life saving drugs to be subsidized. Watch the end of many pharma ads in the us. Not saying he is a saint, but in this case you are ascribing malice where there is none.
    - mikeash 10y ago
      I know the guy jacked up the prices for these drugs enormously, and the stuff I found about people getting it for free if their insurance doesn't cover it is after the controversy got rolling, so I don't think I'm ascribing malice so much as describing it.

soundwave106 10y ago

The issue is the reverse. Shkreli used existing FDA regulations to carve out a monopoly -- from what I understand from the Wiki (https://en.wikipedia.org/wiki/Pyrimethamine#cite_note-45 https://en.wikipedia.org/wiki/Pyrimethamine#cite_note-45), he largely leaned on current FDA bioequivalency standards to put a barrier to entry for the business that was higher than many generics would want to risk (given the low volume of the compound). Once the virtual monopoly was obtained, he subsequently jacked up prices. In this he probably made a mistake by being way too greedy. With "ordinary" medication pricing, patients may not notice the very high prices, largely because American medical pricing is not terribly transparent. Instead, the higher costs tend to translate to higher insurance premiums and higher medical bills to the taxpayer. Pyrimethamine is an old 1950s drug and as I understand it the synthesis is relatively easy. If the current American regulatory system wasn't so broken and we had a truly free market, Shkreli wouldn't even have a business plan with that sort of price increase, low volume notwithstanding. The good news out of this is what Shkreli did was so egregious, the flaws in the system ended up being headline news.